机械通气危重患者卧位与中心静脉压的关系研究

doi:10.20223/j.cnki.1000-8535.2025.06.012

摘要/Abstract

摘要： 目的探讨机械通气危重患者卧位与中心静脉压（CVP）的关系。方法选取2022年1月—2024年1月开封市中医院收治的110例机械通气危重患者作为研究对象进行回顾性分析,依照患者不同卧床体位进行分组,分为平卧位组（n=20）、30°卧位组（n=30）、45°卧位组（n=40）、60°卧位组（n=20）,分析机械通气危重患者卧位与中心静脉压的关系。结果不同体位患者呼吸频率（RR）、心率（HR）、血氧饱和度（SpO₂）、平均动脉压（MAP）比较差异无统计学意义（P>0.05）,不同体位患者CVP水平比较差异有统计学意义,平卧位组更高（P<0.05）;Spearman相关分析结果表明,RR、HR、SpO₂、MAP与体位无相关性（P>0.05）,CVP与体位角度呈负相关（P<0.05）;体位一直无变化的患者5 min、10 min CVP差值比较差异无统计学意义（P>0.05）,5 min内变化体位与5~10 min变化体位患者CVP差值有所变化（P<0.05）;CVP水平可随着体位角度增加而降低,随着呼气末正压（PEEP）水平升高而升高（P<0.05）。结论机械通气危重患者CVP可随着体位及PEEP水平变化而发生改变,因此针对患者监测CVP过程中可尽量让患者保持平卧位5 min后,且确保每次监测过程中PEEP稳定时进行CVP监测,可在监测后再对患者进行体位调整,确保CVP数据准确的同时,提升患者舒适度。

关键词: 机械通气, 危重症, 体位, 中心静脉压, 生命体征参数, 呼气末正压

Abstract: Objective To explore the relationship between lying angle and central venous pressure（CVP）in critically ill patients undergoing mechanical ventilation. Methods A retrospective analysis was conducted on 110 critically ill patients with mechanical ventilation admitted to the hospital from January 2022 to January 2024．The patients were divided into three groups based on their different bed positions：supine position group（n=20）,30° lying angle group（n=30）,45° lying angle group（n=40）,and 60° lying angle group（n=20）．The relationship between CVP and lying angle of patients were compared．Results There was no significant difference in respiratory rate（RR）,heart rate（HR）,blood oxygen saturation（SpO₂）,and mean arterial pressure（MAP）between patients in different lying angle（P>0.05）,and there was a significant difference in CVP among patients in different lying angle．The supine position group had a significantly higher CVP（P<0.05）．The Spearman correlation analysis results showed that RR,HR,SpO₂,MAP were not significantly correlated with lying angle（P>0.05）,while CVP was negatively correlated with body lying angle（P<0.05）．There was no significant difference（P>0.05）in CVP between 5 minutes and 10 minutes in patients with no changes in lying angle,while patients with changes in lying angle within 5 minutes and those between 5 minutes and 10 minutes showed significant changes（P<0.05）．CVP levels decreased with increasing lying angle and increased with increasing PEEP level（P<0.05）．Conclusions The CVP of critically ill patients undergoing mechanical ventilation can change with lying angle and PEEP level．Therefore,during the monitoring of CVP for patients,it is advisable to keep them in a supine position for 5 minutes and ensure that PEEP is monitored simultaneously during each monitoring process．After monitoring,the patient's posture can be adjusted to ensure accurate CVP data and improve patient's comfort level．

Key words: mechanical ventilation, critical illness, position, central venous pressure, vital sign parameters, positive end expiratory pressure

刘辉, 贾翠, 苏艳红. 机械通气危重患者卧位与中心静脉压的关系研究[J]. 广州医药, 2025, 56(6): 804-808.

LIU Hui, JIA Cui, SU Yanhong. The relationship between lying angle and central venous pressure in critically ill patients undergoing mechanical ventilation[J]. Guangzhou Medical Journal, 2025, 56(6): 804-808.

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